Individual
PENELOPE O KACZMAREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1684 N COAST HWY, NEWPORT, OR 97365
(541) 574-4050
Mailing address
1684 N COAST HWY, NEWPORT, OR 97365
(541) 574-4050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1758
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J2730
PACIFIC SOURCE
OR
Enumeration date
12/05/2006
Last updated
07/08/2007
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